Response to the National Association of Medical Examiners Position Paper
on the Certification of Cocaine-Related Deaths.

To the Editor:

The members of the special committee appointed by NAME to review cocaine-related deaths and make recommendations for investigative guidelines are to be commended for devoting their time and professional expertise to this important subject.(1)

There is a critical aspect of these deaths that needs to be emphasized and clarified. While the committee mentions "supervening causes" and "a readily identifiable mechanism or disease," these references do not take into account the most important and controversial feature of such cases, namely, physical altercations with multiple police officers.

The committee refers to "cocaineinduced excited delirium," which is almost always the diagnosis and explana- tion rendered by forensic pathologists and other medical experts in rejecting allegations of suffocation, mechanical or positional asphyxiation, and cardiac arrhythmia precipitated by hypoxia as alternative explanations for sudden death. I believe this is a serious and significant omission in the committee's overall discussion and specific recommendations.

Experienced forensic pathologists recognize and appreciate the fact that each and every death case involving cocaine must be reviewed and analyzed on the basis of its own specific set of facts and circumstances, resulting in differences of opinion from one case to another as to etiology. However, the adamant refusal of some of our colleagues to even consider police misconduct and brutality as the underlying feature of such cases is most regrettable and, in my opinion, morally and ethically indefensible.

Sincerely yours,

Cyril H. Wecht, MD, JD
Coroner, Allegheny County
Adjunct Professor of Law, Duquesne University
Clinical Professor of Pathology, University of Pittsburgh School of Medicine
Past President, American Academy of Forensic Sciences
Past President, American College of Legal Medicine
Pittsburgh, Pennsylvania